A SEMINAR REPORT ON HERPES

SIMPLEX VIURUS (HSV)

BY
ABDULRAQIB OLOLADE ABDULSALAM
21D/57MB/01410
SUPERVISOR- PROF. S.A. AWE
OUTLINE
• Herpes Simplex Virus (HSV)
• Symptoms of Herpes Simplex Virus (HSV)
• Pathogenesis of Herpes Simplex Virus (HSV)
• Diagnosis of Herpes Simplex Virus (HSV)
• Prevention of Herpes Simplex Virus (HSV)
• CONCLUSION
• RECOMMENDATION
• REFERENCE

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Herpes Simplex Virus (HSV)

• Herpes simplex is a viral infection caused by the herpes simplex virus

(Dabestani et al., 2019).

• Oral herpes involves the face or mouth. It may result in small blisters in groups

often called cold sores or fever blisters or may just cause a sore throat.

• Genital herpes, often simply known as herpes, involves the genitalia. It may

have minimal symptoms or form blisters that break open and result in

small ulcers (Durukan et al., 2019)

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Symptoms of Herpes Simplex Virus (HSV)

• Common infection of the skin or mucosa may affect the face and mouth (orofacial

herpes), genitalia (genital herpes), or hands (herpetic whitlow). More serious disorders

occur when the virus infects and damages the eye (herpes keratitis), or invades the

central nervous system, damaging the brain (herpes encephalitis) (Feltner et al., 2016).

• People with immature or suppressed immune systems, such as newborns, transplant

recipients, or people with AIDS, are prone to severe complications from HSV infections

(Feltner et al., 2016).

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Pathogenesis of Herpes Simplex Virus (HSV)

1. Primary Infection and Establishment of Latency

1. Infection with HSV-1 begins with an acute phase, during which the virus rapidly

replicates at the site of contact.

2. HSV-1 establishes a lifelong latent infection in the trigeminal or sacral ganglia,

depending on the initial site of infection.

3. The mechanisms of lytic versus latent infections have been traced to epigenetic

regulation, with viral lytic genes associated with heterochromatin preventing

transcription during latency (Wald et al., 2016).

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Pathogenesis of Herpes Simplex Virus (HSV)

2. Reactivation

i. During the cycle of HSV recurrences, the virus undergoes reactivation from latent to

lytic replication in trigeminal or sacral ganglia neurons with anterograde axonal

transport to epithelial cells.

ii. The virus replicates in epithelial cells and may be shed asymptomatically or may be

associated with clinically apparent ulcerations (Wei et al., 2017).

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Populations at Risk of Herpes Simplex Virus (HSV

i. Sexually Active Adolescents

• As adolescents initiate sexual activity, they are at risk for acquiring either oral or genital

HSV-1 infection.

• Transmission via oral-genital or genital-genital contact has resulted in an increasing

number of cases of genital HSV-1 infection, especially among young women and men

who have sex with men (Johnston et al., 2019).

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Populations at Risk of Herpes Simplex Virus (HSV

ii. Athletes Involved in Contact Sports

• For athletes involved in contact sports (especially wrestlers), cutaneous and ocular

HSV-1 infections have been recognized as a health risk.

• In wrestlers, transmission likely involves contamination of skin abrasions with infected

oral secretions during close contact, resulting in "herpes gladiatorum" (Johnston et al.,

2019)

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Populations at Risk of Herpes Simplex Virus (HSV

iii. Neonates

• Neonatal HSV-1 is transmitted from the maternal genital tract during delivery, often in

the absence of history of genital herpes or lesions evident during labor.

• The risk of HSV-1 transmission from maternal genital secretions to neonates during

birth is substantial if the woman acquired genital HSV-1 during pregnancy or if HSV-1

reactivation occurs in the genital tract at the time of delivery (Li et al., 2018).

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Diagnosis of Herpes Simplex Virus (HSV)

i. Polymerase Chain Reaction

• Real-time HSV polymerase chain reaction (PCR) assays have emerged as the most

sensitive method to confirm HSV infection in clinical specimens obtained from

mucocutaneous sites, including oral and genital ulcers (Nakubulwa et al., 2017).

• Detection of HSV with PCR is more sensitive than culture; in one study, the rate of

HSV-1 detection in self-collected samples from the mouth, nasal mucosa, and tears was

three times higher with PCR (Nakubulwa et al., 2017).

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Diagnosis of Herpes Simplex Virus (HSV)

ii. Viral Culture

• When viral cultures are obtained, viral medium should be immediately transported to

the appropriate laboratory, but it may be stored at 4°C for up to nine hours (Chen et al.,

2017).

• The characteristic cytopathic effects appear in the selected cell line within 24 to 48

hours, especially if the initial inoculum is high (Chen et al., 2017).

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 Prevention of Herpes Simplex Virus (HSV)
i. Use of Condom and Antivirals

• Condoms offer moderate protection against HSV-2 in both men and women, with
consistent condom users having a 30%-lower risk of HSV-2 acquisition compared with
those who never use condoms (Johnston et al., 2019).

• A female condom can provide greater protection than the male condom, as it covers the
labia (Johnston et al., 2019).

• When one partner has a herpes simplex infection and the other does not, the use of
antiviral medication, such as valaciclovir, in conjunction with a condom, further
decreases the chances of transmission to the uninfected partner (Johnston et al., 2019).

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 CONCLUSION
• Genital herpes remains an important STI given the high prevalence of HSV-2. HSV-2 has a key role in fueling

the HIV epidemic and, although rare, HSV-1 and HSV-2 are associated with devastating outcomes when

acquired during pregnancy, both among women and neonates.

• While symptoms of genital herpes can be managed and transmission to sexual partners prevented with antiviral

therapy, novel therapies with new mechanisms of action will improve our ability to care for patients.

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RECOMMENDATION
• Greater availability of nucleic acid amplification tests to diagnose HSV in the setting of genital

ulcers will improve diagnosis in the acute setting, but serologic assays lack diagnostic accuracy and

advances in the diagnostic algorithm as well as new diagnostic tools are needed.

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REFERENCES
• Chen, Fangman, Xu, Hao, Liu, Jinli, Cui, Yuan, Luo, Xiaobo, Zhou, Yu, Chen, Qianming, and Jiang, Lu (2017). "Efficacy and safety
of nucleoside antiviral drugs for treatment of recurrent herpes labialis: a systematic review and meta-analysis". Journal of Oral
Pathology and Medicine. 46 (8):561–568.
• Dabestani, N., Katz, D.A., Dombrowski, J., Magaret, A., Wald, A. and Johnston, C. (2019). Time trends in first-episode genital
herpes simplex virus infections in an urban sexually transmitted disease clinic. Sex Transmission Disease 46:795–800
• Durukan, D., Fairley, C.K. and Bradshaw, C.S. (2019). Increasing proportion of herpes simplex virus type 1 among women and men
diagnosed with first-episode anogenital herpes: a retrospective observational study over 14 years in Melbourne., Australia. Sex
Transmission Infectious 95:307–113
• Feltner, C., Grodensky, C. and Ebel, C. (2016). Serologic screening for genital herpes: an updated evidence report and systematic
review for the US Preventive Services Task Force. 316:2531–2543.
• Johnston, C., Magaret, A. and Stern, M. (2019). Natural history of oral and genital herpes simplex virus type 1 (HSV-1) shedding
and lesions following first episode genital HSV infection. In: World STI & HIV Congress, Vancouver., Canada.
• Li, Z., Breitwieser, F.P., Lu, J., Jun, A.S., Asnaghi, L., Salzberg, S.L. and Eberhart, C.G. (2018). Identifying Corneal Infections in
Formalin-Fixed Specimens Using Next Generation Sequencing. Investment Ophthalmology Visa Science 59(1):280-288.
• Nakubulwa, S., Kaye, D.K., Bwanga, F., Tumwesigye, N.M., Nakku-Joloba, E. and Mirembe, F. (2017). Effect of suppressive
acyclovir administered to HSV-2 positive mothers from week 28 to 36 weeks of pregnancy on adverse obstetric outcomes: a double-
blind randomised placebo-controlled trial. Reproductive Health 14:31-40
• Wald, A., Timmler, B. and Magaret, A. (2016). Effect of pritelivir compared with valacyclovir on genital HSV-2 shedding in patients
with frequent recurrences: a randomized clinical trial. JAMA 316:2495–2503
• Wei, E.Y. and Coghlin, D.T. (2017). Beyond Folliculitis: Recognizing Herpes Gladiatorum in Adolescent Athletes. Journal
Pediatrics 190:283-289.

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THANK YOU

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